As pharmacy professionals, it is our duty of care to ensure that patients receive treatment suited to their needs, in order to provide optimal benefit. An issue that is well known in pharmacy practice is that of over-the-counter pain relief. These consultations can be difficult as it is often hard to determine whether the patient is receiving the correct drug and dose for their pain and that there are no underlying dependency issues.
To address this issue, the student-led Pharmacy Law and Ethics Group at Robert Gordon University held a debate in March this year with the title:
“Is it in the patient’s best interests to ban the sale of OTC opioids to reduce addiction and harm?”.
The debate was led by Annamarie McGregor from the Royal Pharmaceutical Society who gave an unbiased background on the issue of OTC opioid dependence. There is a current estimate that 3-28% of patients on chronic opioid therapy have opioid analgesic independence (OAD), which can stem from predominant comorbidities such as mental health issues and a history of substance misuse. (5) Whilst OAD is a threat to public health, as professionals, we must be aware that pain must still be managed by the use of appropriate treatment. (4) By understanding the balance between benefit and risk of opioid prescribing, patients can be treated with the confidence that their medication will not lead to dependence or adverse events.
Following Annamarie’s introduction, two pharmacy student speakers from the University argued for or against the debate title. Ewan Hardie, a fourth-year student, gave an opposing view and touched on mortality with regards to prescription-only opioids. He explained that deaths involving opioids appear to occur more frequently in those taking prescribed opioids in comparison to OTC users. (3) He also discussed that the majority of OTC opioid users are infrequently purchasing products like co-codamol for short term pain relief. It is these patients who would be impacted by an OTC opioid ban, unable to self-manage ailments whilst adhering to the guidance given by their community pharmacy. (3) Ewan explained that these patients would require to see a GP, impacting on the NHS and increasing their waiting time for acute pain management.
Secondly, Vivien Yu, a second-year student, argued for the debate title. Vivien compared the UK’s current OTC codeine sales to Australia, who banned OTC codeine on the 1st of February 2018 due to research showing low-dose codeine-containing products offered little additional pain relief to non-opioid analgesics. (2) She also explained that by making OTC opioids prescription only, patients would require to have a sit-down conversation with a healthcare professional to ensure that the treatment was the most appropriate for their pain management. (1)
Overall, the debate offered in-depth insight into both the benefits and the risks of prescription and OTC opioid use. A motion was passed involving opinions of those attending the debate. The motion was as follows: “The RGU Pharmacy Law and Ethics Group believe that better safeguarding should be in place with regards to OTC opioid sales, rather than proposing an outright ban. A Pharmacy First approach should be adopted for acute and chronic pain management”. This motion was agreed on as, after a full discussion, it was decided that OTC opioids are required for short-term use to manage acute pain. However, it was suggested that a more in-depth consultation through community pharmacies would benefit patients, ensuring that their pain management is tailored to their needs to reduce the risks of adverse effects and dependence.
Katie Waghorn is a 4th Year MPharm RGU, PLE Group Leader 18/19.
The PIP team would love to know your views on over the counter opiates. Answer the questions below and with your permission, we will publish your response to this story as a letter to the editor.
 ANDALO, D., 2016. Survey of UK public reveals extent of over-the-counter drug misuse and abuse. [online] London: The Pharmaceutical Journal. Available from: here [Accessed May 15th 2019]
 KLEIN, A., 2017. Australia bans non-prescription codeine to fight opioid crisis. [online] London: New Scientist. Available from: here [Accessed May 15th 2019]
 KOLODNY, A. et al., 2015. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. The Annual Review of Public Health, 36, pp. 559-74
 LYAPUSTINA, G. and ALEXANDER, C., 2015. The prescription opioid addiction and abuse epidemic: How it happened and what we can do about it. [online] London: The Pharmaceutical Journal. Available from: here [Accessed May 14th 2019]
 SHAPIRO, H., 2015. Opioid painkiller dependency (OPD): An overview. London: DrugWise.